What next for the health service?

When Alan Johnson became health secretary in the summer of 2007 his first request to his press team was to keep the NHS out of the headlines.

His predecessor, Patricia Hewitt, had spent the previous two years fighting a series of damaging stories from deficits to rows over GP out-of-hours care.

By and large, Mr Johnson succeeded.

But, with an election less than a year away, is the NHS about to burst on the scene again?

The government feels it can be proud of what is has achieved in England - and with a new health team in place ministers are set to put the case in the coming months.

'Exciting'

Speaking at a conference in London organised by Reform, a right-of-centre think-tank, health minister Mike O'Brien said he was "optimistic".

The address - his first to a health audience since being appointed at the weekend - was markedly different in tone to those made by his predecessors.

He said: "Despite the economic gloom, the future of the NHS has never been brighter or more exciting."

WHERE LABOUR STANDS

After 12 years in power, the reform programme is well and truly bedding in with initiatives such as patient choice up-and-running

Funding has more than trebled, paying for thousands more doctors and nurses and a fall in waiting times to 18 weeks for non-emergency hospital treatment

Quality now the mantra with ministers promising to improve the patient experience

He cited the 2m more operations being done each year since Labour came to power thanks to thousands more doctors and nurses being employed.

But after a trebling of the NHS budget and a revamp of the NHS structure, he said it was now time to move on to the next stage of reform.

"We have gone past mere institutional reform to how we improve the quality of the patient experience."

Indeed, quality is the buzz word for the government.

It has already announced the introduction of what are called quality accounts for NHS trusts, which are likely to include details on everything from safety to how well patients have been treated.

Mr O'Brien also said in the future there would need to be more "transparency and openness" among doctors about their performance - to date only heart surgeons produce any kind of detailed breakdown of death rates.

Ideas

But if the government does start talking about health more, it also gives the opposition parties the opportunity to put their ideas forward.

Understandably, many of the policies are still being developed, but the Liberal Democrats and Conservatives clearly believe there is scope to champion their respective groups as the "party of the NHS".

Liberal Democrat health spokesman Norman Lamb said: "I do think the public is more prepared to listen to new ideas. Everyone understands public finances are in a mess."

WHERE THE LIB DEMS STAND

Local health boards would be elected in a bid to encourage innovation and accountablility at a local level

Free personal care to a basic level after which the individual could top-up their package

Reform of dentistry contract to provide better incentives - reports have emerged of dentists running out of funding to provide NHS care - and free check-ups

He described it as a "critical time" for the NHS.

"There is a widespread view that money is not being spent as wisely as it can be."

Mr Lamb said the Lib Dems would scale back on the management and bureaucracy in the health service.

He said this could be achieved by scrapping regional health authorities, scaling back on the size of the Department of Health and reviewing quangos.

Mr Lamb said in their place would be elected health boards to foster power, accountability and innovation at a local level.

But the party also realises elected health bodies do not capture the headlines so already they have unveiled policies to provide free personal care and improve dentistry.

The Tories too have their own structural initiatives including creating an independent NHS board to put an end to "top-down interference".

Patient power

But they have also promised to provide all patients going into hospital for planned treatment their own single room as well as opposing the closure of A&E units and maternity departments.

But central to their vision for the NHS is patient power.

Shadow health secretary said he wanted to create an "information market place" that the government had failed to do so far.

He said the data that has been provided on MRSA rates could be misleading as he knew of hospitals which ended up with poor figures purely because they had specialist units treating severely ill patients from across a large region.

WHERE THE TORIES STAND

Patients to be given better and clearer information about their care to enable them to choose where they want to go and whom they want treating them

An extra 45,000 single rooms to be provided to ensure every patient needing planned care gets their own room

Oppose A&E and maternity unit closures

Mr Lansley explained: "Patients who have more information have a better patient experience and have better outcomes."

But no debate about the future of the NHS can get away from the funding question.

As the BBC reported earlier this week, the health service is facing a deficit of up to £10bn for the three years after 2011 as the government pays back the cost of bailing out the banks.

Mr O'Brien believes improvements in quality can prove cost-effective, citing the £75m a year saving the NHS is enjoying because of the fall in hospital infections.

But others are less sure.

Alan Downey, the UK head of healthcare at KPMG, said: "It is very difficult for political parties to admit to difficult choices.

"Demand for services will continue to rise, for demographic and other reasons, which means that even zero growth will feel like a 5% cut."

He suggested that to cope the NHS's final salary pension scheme had to go, while rationing, user charges and hospital closures would also have to be contemplated.

"The NHS is facing one of its toughest challenges in its 60-year history," he added.

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